Risk factors for steatorrhea in chronic pancreatitis: A cohort of 2153 patients

Risk factors for steatorrhea in chronic pancreatitis: A cohort of 2153 patients

Abstracts / Pancreatology 16 (2016) S1eS63 S8 pancreatitis which has a frequency of 3.3-15%. The spectrum of colonic complications includes a locali...

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Abstracts / Pancreatology 16 (2016) S1eS63

S8

pancreatitis which has a frequency of 3.3-15%. The spectrum of colonic complications includes a localized ileus with “pseudoobstruction”, obstruction, necrosis, hemorrhage, fistula and ischemic colitis. Methods: We present a series of 9 patients who developed colonic fistulae spontaneously during the course of acute necrotizing pancreatitis and following pancreatic necrosectomy for severe acute necrotizing pancreatitis, and 3 cases of patient with large bowel obstruction, which developed 2-3 months after their hospitalization for acute pancreatitis. Results: A colonic fistula was diagnosed at the time of pancreatic necrosectomy in 4 patients; a post-necrosectomy colonic fistula was diagnosed in 5 cases. We performed a diverting loop ileostomy in all the patients with colonic fistulae. Four patients required segmental colectomy and fistula closure occurred in 5 patients with ileostomy alone. In bowel obstruction we found a stenosing tumour located in the splenic flexure and pancreatic necrosis. Left hemicolectomy and pancreatic necrosectomy were performed. Conclusion: A colonic fistula associated with severe acute necrotizing pancreatitis carries a high mortality and an ileostomy should be performed early to divert the faecal stream and control the peritoneal infection. Resection of the fistulated colon was not always required and in some patients the fistulae healed with a diverting ileostomy. In acute pancreatitis cases with extensive pericolitis at surgery the subsequent development of a colonic fistula is likely and an ileostomy (perhaps during necrosectomy) might be an effective pre-empting manoeuvre. In patients with signs of bowel obstruction and recent history of acute pancreatitis a full work-up scan should be performed before surgical treatment for best treatment option and the route of surgical access.

15118. Risk factors for steatorrhea in chronic pancreatitis: A cohort of 2153 patients L.H. Hu 1, 2, *, B.R. Li 1, 2, 3,*, Z. Liao 1, 2, *, T.T. Du 1, Z.S. Li 1, 2 1 Department of Gastroenterology, The Second Military Medical University, Shanghai, China 2 Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China 3 Department of Gastroenterology, Air Force General Hospital, Beijing, China

Objective: To investigate the occurrence and to determinerisk factors of steatorrheain chronic pancreatitis (CP) patients. Design: It was based on retrospective analysis of both retrospectively and prospectively acquired database for CP patients admitted to our center from January 2000 to December 2013. Demographic data, course and medical history, follow-up evaluations weredocumented in detail. The cumulative rates of steatorrhea were analyzed by using the KaplaneMeier method. For risk factor detection, multivariate analysis by Cox proportional hazards regression model was performed. Results: A total of 2153 CP patients were included with an average follow-up duration of 9.3 years. Results showed that approximately 14% (291/2153) of patients showed steatorrhea at CP diagnosis. The cumulative rates of steatorrhea at 1, 5, 10, and 20 years after CP diagnosis were 4.27% (CI: 3.42%-5.34%), 12.53% (CI: 10.74%-14.59%), 20.44% (CI: 17.37%-23.98%) and30.82% (CI: 20.20%-45.21%), respectively. Male gender (HR ¼1.771, p¼0.004), diabetes (HR¼1.923, p<0.001), alcohol abuse (HR¼1.503, p¼0.025)and pancreaticoduodenectomy (HR¼2.901, p<0.001)were risk factors of steatorrhea; adolescent CP (HR¼0.433, p¼0.009) was protective factor. Conclusion: Male gender, adult, diabetes, alcohol abuse and pancreaticoduodenectomy lead to increased risk of steatorrhea. Identification of risk factors might improve pancreatic exocrine insufficiency at the early stage.

*

Drs. Hu, Li, and Liao contributed equally to this study.

15125. Variant pancreatico-biliary ampulla: Is it merely a congenital anomaly without clinical problems? L.C. Prasanna Department of Anatomy, Center for Basic Sciences, Kasturba Medical College, Manipal 576104, India Introduction: The ampulla of Vater is the site of tumors, often with a threatening prognosis, the surgical treatment of which may be consequently difficult. Also, it is the common site of disorders specific to or caused by the neighboring organs that affect bilio-pancreatic emptying. Anatomic details of pancreaticobiliary ampulla and pancreatic duct system are very much essential to avoid postoperative complications of hepato-pancreatic surgeries and for various endoscopic guided interventions like removal of gall stones, drainage of pancreatic pseudocyst and placement of stent into the pancreatic duct in case of malignant pancreatic duct obstruction. The purpose of this study is to present the variations of the ampullary system so that an awareness of these variations may help in surgical planning and prevent ductal injury. Material and methods: The dissection and removal of the duodenum and pancreas was carried out as per the standard protocol given in the Cunningham's dissection manual. The main pancreatic duct was first located in the body of the gland and dissected towards the tail end of the pancreas, and then one percent aqueous solution of eosin was injected through the duct. Both the duodenal papillae were observed for the appearance of the colored fluid indicating patency of the pancreatic ducts. The length of the pancreaticobiliary ampulla and length of the main pancreatic duct were measured using wet thread and slide calipers to avoid possible errors. Results: Observations on the mode of termination of the main pancreatic duct and common bile duct revealed that, the two ducts joined to form a common channel, the pancreaticobiliary ampulla in 30 (75%) out of 40 specimens (Type e I). In 9 (22.5%) specimens, the two ducts ended on the major papilla but remain separated right up to their termination by a complete septum (Type e II). In 1 (2.5%) specimen, the drainage of the entire pancreas was through the duct of Santorini which was opening on to the minor papilla and the duct of Wirsung was obliterated at its duodenal end (Type e III). Length of the pancreaticobiliary ampulla revealed that the length varied from 2 mm to 10 mm. The length varied from 1 to 2 mm in 2 (5%) out of 40 specimens and 3 mm or more in 28 specimens (70%). The pancreaticobiliary ampulla was not formed in 10 specimens (25%). Discussion: In the present study the length of the pancreaticobiliary ampulla varied from 1 to 10 mm (1 to 2 mm - 5%, 3 to 8 mm - 55%, and more than 8mm in 15% of specimens) and it was absent in 25%. The pancreatico-biliary ampulla considered as long common channel if it measures more than or equal to 8 mm. Earlier studies shows a long channel of 15mm is always associated with congenital cystic dilation and gall bladder carcinomas but even, common channel of 8mm is associated with a high incidence of gall bladder carcinomas with a mean length of the common channel in gall stone disease is 4.6mm. In case of long ampulla (more than 8mm), the bile duct is not effectively controlled by the sphincter of Boyden resulting in reflux of pancreatic juice into the biliary tree and mixed with bile, lysolecithin, and phospholipase A2 resulting in chronic inflammation and metaplasia. Conclusion: Pancreaticobiliary diseases are associated with anomalous pancreatic and biliary ductal anatomy and hence every effort should be made in all high risk peoples during ERCP to report the anatomical details of pancreaticobiliary duct and ampulla. Also, awareness of these anomalies may help in surgical planning and prevention of undue ductal injury and by surgically correcting these anomalies one can achieve complete success in recurrent pancreatitis and gastric outlet obstruction.